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Citation: Yeom, H.-E.; Lee, J. Validity
and Reliability of the Basic
Psychological Need Satisfaction and
Frustration Scale Among Cancer
Survivors in Korean Healthcare
Contexts. Healthcare 2024,12, 2535.
https://doi.org/10.3390/
healthcare12242535
Academic Editors: Maria Kapritsou
and Theodoros N. Sergentanis
Received: 3 November 2024
Revised: 12 December 2024
Accepted: 13 December 2024
Published: 16 December 2024
Copyright: © 2024 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
Article
Validity and Reliability of the Basic Psychological Need
Satisfaction and Frustration Scale Among Cancer Survivors in
Korean Healthcare Contexts
Hyun-E Yeom 1,* and Jungmin Lee 2, *
1Department of Nursing, Chungnam National University, Munhwaro 266, Junggu, Daejeon 35015,
Republic of Korea
2Korea Research Institute for Vocational Education & Training, Social Policy Building, Sejong National
Research Complex, 370 Sicheong-daero, Sejong-si 30147, Republic of Korea
*Correspondence: yeom@cnu.ac.kr (H.-E.Y.); jminlee@krivet.re.kr (J.L.);
Tel.: +82-42-580-8327 (H.-E.Y.); +82-44-415-3513 (J.L.)
Abstract: Background/Objectives: Basic psychological needs are essential for fostering motivation,
self-regulated behaviors, and overall well-being. For cancer survivors, fulfilling these needs is crucial
for coping with the various challenges of survivorship and for enhancing psychosocial health. This
study aimed to assess the validity and reliability of the Korean version of the Basic Psychological
Needs Satisfaction and Frustration Scale (K-BPNSFS) in a cancer survivor population. Methods: A
cross-sectional design was employed, involving 367 community-dwelling cancer survivors. Construct
validity was assessed using confirmatory factor analysis with multiple fit indices, while convergent
validity was examined through Pearson’s correlation coefficients. Reliability was evaluated using
internal consistency, inter-item correlations, and item-total correlations. Results: The findings con-
firmed a robust six-factor structure of the K-BPNSFS, which includes satisfaction and frustration
dimensions corresponding to autonomy, relatedness, and competence needs. Convergent validity
was supported by significant correlations with relevant constructs, aligning with the scale’s theoretical
underpinnings. Reliability analysis demonstrated high internal consistency across all dimensions,
with strong Cronbach’s alpha values and substantial item-total and inter-item correlations. Conclu-
sions: This study establishes the K-BPNSFS as a valid, reliable, and culturally relevant instrument for
assessing the basic psychological needs of Korean cancer survivors. Application of this scale provides
critical insights into the unique psychological needs of this population, supporting the development
of targeted healthcare strategies to enhance intrinsic motivation, self-care, and overall quality of life.
Keywords: patient self-determination act; motivation; needs assessment; validation study;
psychometric
;
cancer survivors
1. Introduction
With advances in medical techniques improving survival rates, cancer is now recog-
nized as a chronic condition requiring long-term management throughout the survivorship
journey [
1
,
2
]. Cancer survivors encounter multifaceted physical and psychological chal-
lenges during the phases of active therapy, recovery, and follow-up, which significantly
affect their fundamental health needs [
2
]. An expanding body of health literature highlights
the strong association between individuals’ psychological needs, intrinsic motivation, and
their capacity to navigate life’s complexities, underscoring the importance of addressing
these diverse needs [
3
]. Empirical research further demonstrates the pivotal role of psy-
chological needs in enhancing health outcomes for cancer survivors [
4
–
7
]. These needs
have been linked to various aspects of well-being, including physical and mental health for
testicular cancer survivors [
4
], social well-being in older cancer survivors [
5
], engagement
in physical activity among colorectal cancer survivors [
6
], and self-management in breast
Healthcare 2024,12, 2535. https://doi.org/10.3390/healthcare12242535 https://www.mdpi.com/journal/healthcare
Healthcare 2024,12, 2535 2 of 13
cancer survivors [
7
]. In light of the enduring challenges of survivorship, it is essential
to understand the psychological needs of cancer survivors to enhance motivation and
behaviors that lead to an overall improved quality of life.
Self-determination theory (SDT), a conceptual framework guiding psycho-cognitive
behavioral studies, focuses on three basic psychological needs (BPN)—autonomy, related-
ness, and competence—that are innate traits facilitating motivation, leading to behavioral
changes and personal growth [
8
–
10
]. Autonomy refers to the experience of making choices
and acting according to one’s own will, giving the individual a sense of control over their
actions and life [
8
]. Relatedness involves forming meaningful relationships with others,
feeling connected and belonging, and experiencing support, understanding, and respect
through social interactions [
8
]. Competence refers to the perception of effectively and
successfully interacting with the environment, solving challenging tasks, and experiencing
a sense of achievement by applying one’s abilities [8].
SDT posits that whether these needs are fulfilled or frustrated affects intrinsic motiva-
tion and self-driven behaviors that are linked to psychological well-being [
9
,
11
]. Aligned
with this proposition, numerous empirical studies have demonstrated that satisfaction and
frustration with the BPN are associated with distinctive aspects of self-regulated behaviors,
psychological integration, and overall well-being in school education [
12
], sports [
13
], par-
enting [
14
], and healthcare [
15
]. Further, SDT postulates that the satisfaction and frustration
of BPN are not reverse concepts [
9
,
15
,
16
], implying that the satisfaction and frustration
of the BPN to be considered as independent features representing the unique status of
BPN [
9
]. For instance, the healthcare literature emphasizes that the satisfaction of BPN is
essential for fostering active engagement in healthy behaviors, such as maintaining regular
physical activity and adhering to a balanced diet [
7
,
17
]. Conversely, the frustration of
these needs is associated with maladaptive health behaviors, such as reduced intrinsic
motivation for exercise [
18
] and adverse health outcomes [
19
]. These findings highlight the
conceptual distinction between need satisfaction and frustration, demonstrating that they
are not merely opposite ends of a continuum. This distinction underscores the importance
of examining both aspects of BPN to fully understand the experiences of cancer survivors.
The Basic Psychological Need Satisfaction and Frustration Scale (BPNSFS) has been
used as a valid tool for assessing the extent to which individuals’ BPN are fulfilled or
thwarted [
9
,
15
,
16
]. Satisfaction with these needs represents feeling in control of one’s
actions (autonomy), feeling connected to others (relatedness), and feeling competent (com-
petence). In comparison, frustration reflects the status of these needs being unmet, such
as feeling controlled or pressured (lack of autonomy), feeling isolated or socially discon-
nected (lack of relatedness), and feeling inadequate or ineffective (lack of competence). As
such, the BPNSFS provides a comprehensive framework for assessing the satisfaction and
frustration of core psychological needs.
The original BPNSFS has been translated into several languages, including Japanese [
20
],
Italian [
21
], German [
22
], Polish [
23
], and Arabic [
24
]. Validation studies of these transla-
tions consistently confirm a six-dimensional structure that captures both satisfaction and
frustration related to the three psychological needs (i.e., autonomy, relatedness, and compe-
tence). This dual focus on fulfilled and unmet needs offers a more nuanced understanding
of psychological needs, enhancing its utility in health research and psychological interven-
tions for individuals confronting health-related challenges. However, existing studies of
medical contexts, including cancer survivors [
4
–
8
], have predominantly focused on the
satisfaction of BPN, often overlooking the equally critical aspect of need frustration. Further-
more, while the BPNSFS has been validated for assessing BPN in individuals with specific
health conditions, such as mental well-being/ill-being [23], depression [24], and HIV [25],
its application to cancer survivors remains largely unexplored. This gap underscores the
need for further research to evaluate its relevance and validity in this population.
Cancer survivors encounter numerous hardships, including distress from uncertainty,
anxiety about recurrence, social isolation during treatment, and physical discomfort [
1
,
2
,
4
,
5
].
These challenges can profoundly impact their BPN. While BPN are regarded as a universal
Healthcare 2024,12, 2535 3 of 13
innate trait across diverse ages and socio-cultural contexts [
8
,
9
], limited research exists
on the distinctive patterns of BPN satisfaction and frustration among cancer survivors.
Although one study examined the BPN of cancer survivors in Korea [
17
], it concentrated
exclusively on satisfaction, leaving the aspect of frustration unexamined. Utilizing the
BPNSFS to this population offers an opportunity to provide health professionals with
essential insights into the balance between positive and negative psychological experiences
throughout the cancer survivorship journey. Considering the specific psychological and
behavioral challenges faced by cancer survivors, this study aimed to investigate the va-
lidity and reliability of the BPNSFS within the Korean context. By establishing a critical
foundation for understanding the psychological needs of cancer survivors, this research
provides valuable insights to guide clinical practices aimed at enhancing their motivation,
self-care behaviors, and overall quality of life.
2. Materials and Methods
2.1. Design
This cross-sectional study employed a methodological approach, utilizing secondary
data from two primary studies. Study 1 explored the relationships among interpersonal,
psychological, and behavioral characteristics and their impact on health-related quality
of life in a sample of 220 breast cancer survivors. Study 2 investigated psycho-cognitive
and social determinants of self-care behaviors in 147 blood-cancer survivors [
26
]. Both
studies focused on understanding how psycho-cognitive traits influence active self-care
and enhance overall well-being throughout the cancer survivorship journey.
2.2. Sample and Process
Participants were recruited through convenience sampling from outpatient and inpa-
tient facilities at Chungnam National University Hospital in Daejeon, the fifth-largest city
in South Korea. Eligibility criteria for both Study 1 and Study 2 included being 19 years
or older and not currently undergoing active cancer-related treatment, such as surgery
or hematopoietic stem cell transplantation. Participants were also required to have only
primary breast or blood cancer, with no other cancer types present. Additionally, partici-
pants needed to exhibit healthy cognitive functioning, be capable of communicating and
understanding the questionnaires, and to respond to each item. Exclusion criteria were
established to remove individuals receiving palliative care at the end-of-life stage or those
referred to hospice care.
This study utilized data from 367 participants, including 220 breast-cancer survivors
and 147 blood-cancer survivors. In terms of statistical power, a sample size of 367 was
sufficient to assess structural validity through confirmatory factor analysis (CFA), which
requires at least a 10:1 ratio of cases to free parameters [
27
]. Given that the BPNSFS consists
of 24 items, the necessary sample size should exceed 240 under these criteria. Thus, the
sample size supported construct validity with adequate statistical power.
2.3. Measures
2.3.1. Korean Version of BPNSFS
The BPNSFS had not previously been translated or validated in Korean. Therefore,
the original English version of the BPNSFS [
16
] was translated into Korean following a
rigorous five-step process for cross-cultural adaptation of measurement tools [
28
]. This
process included translation, synthesis, back-translation, content validity review, and pilot
testing to ensure linguistic accuracy and cultural relevance.
The translation and synthesis were performed by three bilingual Korean-English
translators to maintain linguistic accuracy while ensuring cultural relevance. A profes-
sional editor conducted a meticulous back-translation, carefully identifying and resolving
discrepancies to preserve the original questionnaire’s integrity and eliminate potential
back-translation errors. This step was critical in ensuring the Korean version accurately
reflected the original contents while being understandable to Korean respondents.
Healthcare 2024,12, 2535 4 of 13
Following this process, an expert panel comprising six Korean psychologists specializ-
ing in SDT-based research and three oncology clinical nurse specialists reviewed the content
validity of the translated items. Using the content validity ratio (CVR) [
29
], the experts
evaluated the appropriateness of terminology, accuracy of meaning, and socio-cultural
relevance of each item. All items achieved a CVR of 0.556 or higher, indicating that the
panel deemed most items essential. This high CVR score reflects strong agreement among
the experts regarding the importance of the items for measuring the intended constructs.
Finally, a pilot test was conducted with ten cancer survivors to assess the clarity,
comprehensibility, and cultural appropriateness of the translated items. Feedback from
the pilot participants was utilized to refine the questionnaire further, ensuring that all
items were understandable and allowed for accurate responses. Following this rigorous
process, the Korean version of the BPNSFS (K-BPNSFS) was finalized. The scale comprises
24 items representing six dimensions: needs satisfaction of autonomy (items 1 through
4), relatedness (items 9 through 12), and competence (items 17 through 20) as well as
needs frustration of autonomy (items 5 through 8), relatedness (items 13 through 16), and
competence (items 21 through 24). Each dimension includes four items rated on a 5-point
Likert scale, with responses ranging from 1 (“definitely no”) to 5 (“definitely yes”).
2.3.2. Self-Acceptance and Depression: Validating Autonomy Needs
To assess the conceptual relevance of autonomy needs, the constructs of self-acceptance
and depression were employed, reflecting established research connections between auton-
omy, internal empowerment, and psychological well-being in cancer populations [
30
,
31
].
Self-acceptance was assessed using the Self-Acceptance dimension of Ryff’s Psychological
Well-being [
32
,
33
]. This eight-item scale is designed to assess an individual’s positive
evaluation and acceptance of themselves and their past, capturing their acknowledgment
and integration of personal strengths and weaknesses. The scale has been validated in
both Western and Korean populations [
32
,
33
]. Participants rated their level of agreement
on a 6-point Likert scale, with higher scores indicating a more positive self-attitude and a
greater capacity to accept various aspects of oneself. The measure demonstrated strong
internal consistency in Study 1, with a Cronbach’s alpha of 0.809.
Depression was evaluated using the Patient Health Questionnaire-9, a nine-item
measure validated in Korea [
34
]. Participants rated the frequency of specific depressive
symptoms over the past two weeks on a 4-point Likert scale. Higher scores indicate more
depressive symptoms. This scale showed sufficient reliability, achieving a Cronbach’s alpha
of 0.858 in Study 2.
2.3.3. Family Interaction: Validating Relatedness Needs
The conceptual relevance of relatedness needs was explored by evaluating family
interactions, which play a crucial role in fostering a sense of belonging and connection [
35
].
Family interaction was measured using the validated Family APGAR scale, which assesses
core dimensions of family functioning, including adaptation, partnership, growth, affection,
and resolve among family members [
36
,
37
]. This scale comprises five items rated on a
three-point scale (0 = “hardly ever”; 1 = “sometimes”; 2 = “almost always”), with total
scores ranging from 0 to 10. Higher scores indicate stronger family interaction. The scale
demonstrated strong reliability, with Cronbach’s alphas of 0.894 in Study 1 and 0.881 in
Study 2.
2.3.4. Self-Efficacy and Uncertainty: Validating Competence Needs
The constructs of self-efficacy and uncertainty were selected to evaluate the conceptual
relevance of competence needs, aligning with the literature on cancer-related coping and
perceived competence [
38
,
39
]. Self-efficacy was measured using a 10-item General Self-
Efficacy Scale, which has been validated across diverse populations [
40
]. Respondents
rated their perceived competence in various situations on a 4-point Likert scale, with higher
Healthcare 2024,12, 2535 5 of 13
scores indicating greater self-efficacy. The scale demonstrated excellent internal consistency
in Study 1, with a Cronbach’s alpha of 0.916.
Uncertainty was assessed using Mishel’s Uncertainty in Illness Scale, a validated
instrument designed to measure psychological distress stemming from ambiguity and com-
plexity in cancer populations, including Korean individuals [
41
,
42
]. The scale comprises
23 items, with responses rated on a 5-point Likert scale, where higher scores indicate greater
levels of uncertainty regarding health-related concerns. In Study 2, the scale demonstrated
good internal consistency, with a Cronbach’s alpha of 0.837.
2.3.5. General and Health-Related Characteristics
Demographic information, including age, sex, educational level, marital status, living
arrangements, employment status, and household income, was collected. Health-related
characteristics were also documented, including general health status, body mass index,
time since diagnosis, and cancer treatment history.
2.4. Ethical Consideration
The study protocols, objectives, and all associated methodologies for primary stud-
ies 1 and 2 were approved by the Institutional Review Boards at Chungnam National
University (202101-SB-009-01) and Chungnam National University Hospital (2021-06-080-
006), respectively. Data collection commenced after each participant provided written
informed consent, in accordance with the ethical standards established by the institutional
review boards. This process ensured compliance with the ethical guidelines for conducting
research involving human subjects.
2.5. Statistical Analysis
This study conducted a series of evaluations to assess the construct validity of the
K-BPNSFS, focusing on its six-factor structure and criterion-related validity. Data were
analyzed using Mplus version 7.0 (Muthén & Muthén, Los Angeles, CA, USA). Preliminary
and descriptive statistics for all study variables were computed to provide an overview.
To evaluate construct validity, the structural model of K-BPNSFS was examined using
CFA with maximum likelihood estimation. Multiple indices were applied to assess the
goodness of fit:
χ2
/df (<3), Comparative Fit Index (CFI > 0.90), Tucker–Lewis Index
(TLI > 0.90), Root Mean Square Error of Approximation (RMSEA < 0.08), and Standardized
Root Mean Square Residual (SRMR < 0.08) [
43
,
44
]. The Average Variance Extracted (AVE)
was calculated from the CFA, with a cut-off value of 0.50 used to determine the adequacy
of validity.
For criterion-related convergent validity, Pearson’s correlation coefficients between
K-BPNSFS sub-dimensions and relevant variables were calculated: self-acceptance and
depression for autonomy needs, family interaction for relatedness needs, and self-efficacy
and uncertainty for competence needs.
Internal consistency was assessed using Cronbach’s alpha coefficients for the K-
BPNSFS sub-dimensions, composite reliability (CR) derived from CFA, and item-total
and inter-item correlations. A CR value above 0.70 and a Cronbach’s alpha of 0.60 or higher
were considered indicators of acceptable reliability, indicating that the items measure
a consistent underlying construct [
45
,
46
]. Additionally, item-total correlations (ranging
from 0.30 to 0.80) and inter-item correlations (exceeding 0.15) were taken into considera-
tion [
47
,
48
]. These thresholds were applied to ensure that the items contribute meaningfully
to the overall scale and accurately capture the construct through its components. This
process further confirms the scale’s reliability and validity in measuring the psychological
construct of interest.
Healthcare 2024,12, 2535 6 of 13
3. Results
3.1. Descriptive Characteristics of the Participants
The average age of 367 participants was 54.87 years (SD = 11.78). Most participants
were married (79.8%) and had an educational background beyond high school graduation
(81.5%). Overall, they reported moderate to good health status, with an average rating
of 3.02 out of 5 (SD = 0.90) and a mean BMI of 23.22 (SD = 3.60). The average time since
the initial cancer diagnosis was 25.41 months (SD = 22.16). Among the breast-cancer
survivors, 188 out of 220 underwent lumpectomy or mastectomy. Among the blood-
cancer survivors, 127 received only chemotherapy, while 53 underwent hematopoietic stem
cell transplantation.
3.2. Confirmatory Factor Analysis for the Six-Factor Structural Model
The goodness of fit of the six-factor structural model of the K-BPNSFS was as follows:
χ2
= 447.334 (df = 235, p< 0.001); RMSEA = 0.050 (90% CI: 0.043 to 0.057); CFI = 0.953;
TLI = 0.945; SRMR = 0.059. Item 5 had a factor loading of 0.215, which falls below the typical
threshold for acceptability in confirmatory factor analysis. However, it was retained due
to its strong correlations with other items and its significant contribution to the structural
model. This decision was further supported by the overall favorable fit indices and patterns
observed in previously translated versions [
20
,
23
], which also indicated comparatively low
factor loading for this item. Table 1presents the goodness-of-fit indices for the model, and
Figure 1provides a detailed depiction of the six-factor structure of the K-BPNSFS. These
results affirm the robustness and adequacy of the six-factor structure, aligning with the
original BPNSFS, in accordance with established guidelines [43,44].
Table 1. Construct validity and reliability of the K-BPNSFS (N = 367).
Sub-Dimensions Item FL EE AVE CR Cronbach’s α
Autonomy
Satisfaction
Item 1 0.723 0.030
Item 2 0.829 0.022 0.601 0.989 0.851
Item 3 0.817 0.023
Item 4 0.727 0.030
Frustration
Item 5 0.215 0.058
Item 6 0.657 0.042 0.381 0.990 0.672
Item 7 0.734 0.038
Item 8 0.711 0.039
Relatedness
Satisfaction
Item 9 0.558 0.043
Item 10 0.544 0.044 0.476 0.994 0.810
Item 11 0.802 0.030
Item 12 0.809 0.030
Frustration
Item 13 0.714 0.032
Item 14 0.803 0.026 0.524 0.995 0.803
Item 15 0.745 0.030
Item 16 0.621 0.038
Competence
Satisfaction
Item 17 0.892 0.014
Item 18 0.928 0.011 0.767 0.997 0.938
Item 19 0.850 0.017
Item 20 0.831 0.019
Frustration
Item 21 0.521 0.043
Item 22 0.784 0.028 0.506 0.998 0.793
Item 23 0.779 0.028
Item 24 0.730 0.031
Note. K-BPNSFS: Korean version of the Basic Psychological Needs Satisfaction and Frustration Scale; AVE:
average variance extracted; CR: composite reliability; EE: error estimate; FL: factor loading.
Healthcare 2024,12, 2535 7 of 13
Healthcare 2024, 12, x FOR PEER REVIEW 7 of 13
Item 24 0.730 0.031
Note. K-BPNSFS: Korean version of the Basic Psychological Needs Satisfaction and Frustration
Scale; AVE: average variance extracted; CR: composite reliability; EE: error estimate; FL: factor load-
ing.
Figure 1. Six-dimensional structure with standardized parameter estimates: Results from the CFA
of the K-BPNSFS. Note. K-BPNSFS: Korean version of the Basic Psychological Needs Satisfaction
and Frustration Scale; NS: needs satisfaction; NF: needs frustration; CFA: Confirmatory Factor Anal-
ysis; chi-square test of model fit = 447.334 (df = 235), Root Mean Square Error of Approximation
(RMSEA) = 0.050 (0.043, 0.057); Comparative Fit Index (CFI) = 0.953; Tucker–Lewis Index (TLI) =
0.945, * p < 0.05, *** p < 0.001.
Additionally, CFA conducted on two specific subgroups by cancer type reaffirmed
the consistency of the six-factor structure with the original scale. For the breast-cancer
subgroup, the fit indices were as follows: χ2 = 405.48 (df = 235, p < 0.001); RMSEA = 0.057
(90% CI: 0.048 to 0.067); CFI = 0.940; TLI = 0.942; SRMR = 0.070. For the blood-cancer sub-
group, the fit indices were as follows: χ2 = 323.04 (df = 235, p < 0.001); RMSEA = 0.050 (90%
CI: 0.036 to 0.063); CFI = 0.950; TLI = 0.941; SRMR = 0.064. These findings underscore the
scale’s robust applicability and validity across different cancer survivor populations.
Figure 1. Six-dimensional structure with standardized parameter estimates: Results from the CFA
of the K-BPNSFS. Note. K-BPNSFS: Korean version of the Basic Psychological Needs Satisfaction
and Frustration Scale; NS: needs satisfaction; NF: needs frustration; CFA: Confirmatory Factor
Analysis; chi-square test of model fit = 447.334 (df = 235), Root Mean Square Error of Approximation
(RMSEA) = 0.050 (0.043, 0.057); Comparative Fit Index (CFI) = 0.953; Tucker–Lewis Index (TLI) = 0.945,
*p< 0.05, *** p< 0.001.
Additionally, CFA conducted on two specific subgroups by cancer type reaffirmed
the consistency of the six-factor structure with the original scale. For the breast-cancer
subgroup, the fit indices were as follows:
χ2
= 405.48 (df = 235, p< 0.001); RMSEA = 0.057
(90% CI: 0.048 to 0.067); CFI = 0.940; TLI = 0.942; SRMR = 0.070. For the blood-cancer
subgroup, the fit indices were as follows: χ2= 323.04 (df = 235, p< 0.001); RMSEA = 0.050
(90% CI: 0.036 to 0.063); CFI = 0.950; TLI = 0.941; SRMR = 0.064. These findings underscore
the scale’s robust applicability and validity across different cancer survivor populations.
3.3. Criterion-Related Convergent Validity
Table 2presents correlations between the six dimensions of the K-BPNSFS and the-
oretically relevant constructs, supporting the criterion-related convergent validity. The
dimension of autonomy demonstrated significant correlations with self-acceptance and
depressive symptoms: Satisfaction with the need for autonomy was positively associ-
Healthcare 2024,12, 2535 8 of 13
ated with self-acceptance (r = 0.588, p< 0.001) and negatively with depressive symptoms
(r =
−
0.390, p< 0.001). In contrast, frustration in the need for autonomy showed negative
correlations with self-acceptance (r =
−
0.272, p< 0.001) and positive correlations with
depressive symptoms (r = 0.178, p< 0.001).
Table 2. Correlations between six dimensions of K-BPNSFS and theoretically relevant construct.
Autonomy Relatedness Competence
Satisfaction
r (p)
Frustration
r (p)
Satisfaction
r (p)
Frustration
r (p)
Satisfaction
r (p)
Frustration
r (p)
Self-acceptance 10.588 (<0.001) −0.272 (<0.001) - - - -
Depression 2−0.390 (<0.001) 0.178 (<0.001) - - - -
Family interaction 1- - 0.502(<0.001) −0.404 (<0.001) - -
Family interaction 2- - 0.369 (<0.001) −0.300 (<0.001) - -
Self-efficacy 1- - - - 0.579 (<0.001) −0.542 (<0.001)
Uncertainty 2- - - - −0.296 (<0.001) 0.396 (<0.001)
Note. K-BPNSFS: Korean version of the Basic Psychological Needs Satisfaction and Frustration Scale.
1
Breast-
cancer survivors (n = 220); 2blood-cancer survivors (n = 147).
The dimensions related to the need for relatedness showed significant associations
with family interaction. Satisfaction with the need for relatedness was positively correlated
with family interaction (breast-cancer: r = 0.502, p< 0.001; blood-cancer: r = 0.369, p< 0.001).
In comparison, frustration in the need for relatedness was negatively correlated with family
interaction (breast-cancer: r = −0.404, p< 0.001; blood-cancer: r = −0.300, p< 0.001).
Regarding the need for competence, satisfaction was positively correlated with self-
efficacy (r = 0.579, p< 0.001) and negatively correlated with uncertainty (r =
−
0.296,
p< 0.001). Conversely, frustration in the need for competence was negatively associated
with self-efficacy (r =
−
0.542, p< 0.001) and positively associated with uncertainty (r = 0.396,
p< 0.001).
3.4. Reliability
The internal consistency of each of the six dimensions of the K-BPNSFS was evaluated
using Cronbach’s alpha coefficients, inter-item correlations, and item-total correlations.
Tables 1and 3detail the internal consistency metrics for the sub-dimensions of the
K-BPNSFS. The alpha coefficient for need satisfaction for autonomy was 0.851, indicating
good reliability. The reliability for need frustration for autonomy was slightly lower at
0.672, suggesting moderate internal consistency. Need satisfaction for relatedness showed
a Cronbach’s alpha of 0.810, while need frustration for relatedness had an alpha of 0.803,
indicating good reliability. The satisfaction of competence needs demonstrated excellent
internal consistency, with a Cronbach’s alpha of 0.938. The reliability for frustration of
competence needs was also acceptable, with a Cronbach’s alpha of 0.793. Table 3presents
the Cronbach’s alpha values for each item if deleted, as derived from the item analysis.
The inter-item correlations (0.238
≤
r
≤
0.872) within the K-BPNSFS indicated signifi-
cant internal consistency among the items. The results met the acceptable range criteria, ex-
ceeding 0.15. Additionally, except for item 5, the item-total correlations (
0.455 ≤r≤0.873
),
which measure how well each item correlates with the total score, were within an adequate
range. These results indicate that the items are related but not redundant, which is desirable
on a psychometric scale.
Healthcare 2024,12, 2535 9 of 13
Table 3. K-BPNSFS item analysis: Means, standard deviations, and Cronbach’s alpha if item deleted
(N = 367).
Item M (SD) ITC
r
Cronbach’s α
If Item Deleted
Satisfaction of autonomy needs
1 I feel a sense of choice and freedom in the things I undertake 4.136 (1.080) 0.647 0.830
2 I feel that my decisions reflect what I really want 4.071 (0.986) 0.740 0.792
3 I feel my choices express who I really am 3.937 (1.002) 0.739 0.791
4 I feel I have been doing what really interests me 3.823 (1.123) 0.649 0.831
Frustration of autonomy needs
5 Most of the things I do feel like “I have to” 3.657 (1.170) 0.213 0.735
6 I feel forced to do many things I wouldn’t choose to do 3.864 (1.026) 0.468 0.602
7 I feel pressured to do too many things 4.174 (0.982) 0.607 0.488
8 My daily activities feel like a chain of obligations 4.362 (0.870) 0.558 0.528
Satisfaction of relatedness needs
9 I feel that the people I care about also care about me 3.855 (1.064) 0.648 0.757
10 I feel connected with people who care for me, and for whom I care 3.918 (1.068) 0.651 0.750
11
I feel close and connected with other people who are important to me
3.785 (1.099) 0.660 0.747
12 I experience a warm feeling with the people I spend time with 3.785 (1.086) 0.571 0.789
Frustration of relatedness needs
13 I feel excluded from the group I want to belong to 3.943 (1.037) 0.629 0.750
14 I feel that people who are important to me are cold and distant
towards me 1.839 (1.065) 0.677 0.729
15 I have the impression that people I spend time with dislike me 2.481 (1.386) 0.636 0.749
16 I feel the relationships I have are just superficial 2.297 (1.356) 0.559 0.787
Satisfaction of competence needs
17 I feel confident that I can do things well 1.733 (1.068) 0.823 0.928
18 I feel capable at what I do 1.462 (0.865) 0.861 0.916
19 I feel competent to achieve my goals 1.403 (0.840) 0.873 0.912
20 I feel I can successfully complete difficult tasks 1.883 (1.061) 0.851 0.919
Frustration of competence needs
21 I have serious doubts about whether I can do things well 2.500 (1.202) 0.455 0.812
22 I feel disappointed with many of my performance 2.144 (1.180) 0.684 0.701
23 I feel insecure about my abilities 2.234 (1.178) 0.665 0.710
24 I feel like a failure because of the mistakes I make 1.956 (1.230) 0.618 0.734
Note. K-BPNSFS: Korean version of the Basic Psychological Needs Satisfaction and Frustration Scale; ITC:
item-total correlation.
4. Discussion
As an inherent aspect of human nature, BPN play a key role in activating intrinsic
motivation and behavioral outcomes intricately associated with personal growth and
psychological well-being [8,9]. This study validated the reliability and applicability of the
K-BPNSFS for assessing the satisfaction and frustration of BPN—autonomy, relatedness,
and competence—among cancer survivors in Korea.
Our findings affirm that, consistent with the original version, the K-BPNSFS consists of
a six-dimensional structure classified into satisfaction and frustration dimensions for each
BPN. This structure also aligns with the features verified in other translated versions across
diverse populations from Western and Asian countries [
20
–
23
]. While BPN are considered
an intrinsic trait of human beings, and the BPNSFS has been validated for assessing BPN in
individuals with specific health-related issues [
23
,
24
], its applicability, specifically among
cancer survivors, has been underexplored. Therefore, our findings significantly contribute
by demonstrating that the K-BPNSFS is a reliable, valid, and culturally appropriate tool
for the oncological context in Korea. Furthermore, these findings support the foundational
principles of SDT, emphasizing the universality of BPN across various populations and
socio-cultural environments [10–12,16].
The current study confirmed the convergent validity of the K-BPNSFS by demonstrat-
ing that satisfaction and frustration in each of the BPN are associated with psycho-cognitive
Healthcare 2024,12, 2535 10 of 13
constructs in directions that are both theoretically and empirically supported [
3
–
8
]. Specifi-
cally, higher levels of satisfaction in needs for autonomy, relatedness, and competence were
associated with greater self-acceptance, family interaction, and self-efficacy, respectively.
Conversely, higher levels of frustration in needs for autonomy, relatedness, and compe-
tence were linked to more depressive symptoms, poorer family interaction, and increased
uncertainty. These results align with existing theoretical and empirical evidence, which
indicates that distinct values between satisfaction and frustration for specific needs are
inversely related to well-being and ill-being [
30
,
35
,
38
,
39
,
49
]. Therefore, the evidence of
convergent validity underscores the value of the K-BPNSFS as an effective instrument for
assessing the unique status of BPN among cancer survivors, highlighting its critical role in
developing strategies to enhance self-directed motivation and overall well-being.
This study demonstrated strong internal consistency across the six dimensions of the
K-BPNSFS. Acceptable inter-item and item-total correlations demonstrate robust internal
consistency, suggesting that the items are well-aligned with the overall measured construct.
Cronbach’s alpha coefficients of the satisfaction sub-dimensions were 0.851 for autonomy,
0.810 for relatedness, and 0.938 for competence, all exceeding the acceptable threshold of
0.7 [
36
,
47
]. For the frustration sub-dimensions, alpha values were 0.672 for autonomy, 0.803
for relatedness, and 0.793 for competence, showing acceptable but slightly lower reliability
than the satisfaction sub-dimensions. The relatively lower internal consistency in the
frustration of the autonomy needs may reflect the complex and multifaceted nature of this
frustration, which encompasses feelings of constraint and lack of control [
50
]. This finding
may also be influenced by cultural differences, as autonomy is often less emphasized and
perceived as a less inherent resource in Eastern cultural contexts compared to Western
cultures [
51
,
52
]. Furthermore, Cronbach’s alpha can underestimate reliability for scales
with diverse item content or a small number of items [
53
], as is the case with this four-item
sub-dimension. Notably, the acceptable item-total correlations for the autonomy frustration
dimension indicate that each item contributes significantly to the overall measurement,
supporting the scale’s validity. Therefore, the slightly lower alpha value does not detract
from the scale’s construct validity.
While this study provides valuable insights, its findings have limited generalizability
due to the focus on two independent samples of breast- and blood-cancer survivors. Addi-
tionally, the sample consisted of relatively stable cancer survivors, excluding individuals
with advanced or terminal-stage cancer. Future research should address to overcome
these limitations by incorporating a more diverse range of cancer types and stages as well
as larger sample sizes to enhance the robustness and applicability of the findings across
broader populations. Moreover, while the existing literature highlights the relevance of
BPN across different age groups, evidence from extensive cohort studies suggests that
the fulfillment and frustration of BPN can vary depending on life events and circum-
stances [
54
]. Additionally, the participants in this study were predominantly middle-aged
to older adults, which aligns with the typical age range for cancer incidence. Although
previous research has confirmed the six-dimensional structure of the BPNSFS in diverse age
groups, including adolescents and young adults [
55
], further studies involving a broader
age range are necessary to fully establish the scale’s generalizability across the lifespan.
Therefore, additional research is needed to strengthen the evidence base and validate the
applicability of the K-BPNSFS across diverse populations.
The SDT framework has been applied to psycho-cognitive behavioral studies to under-
stand the unique psychological needs of individuals faced with diverse challenges through
socio-cultural living contexts and their links with internal motivation, self-driven behaviors,
and health outcomes [
7
,
8
]. Our findings substantiate that the K-BPNSFS can capture the
psychological needs of cancer survivors in the distinguished aspects of satisfaction and frus-
tration of BPN. As such, the validated application of this scale shows promise in guiding
cancer survivors toward self-regulated motivation and informed decision making related
to behavioral changes, ultimately enhancing their overall quality of life. Furthermore, our
findings broaden its applicability and support cross-cultural comparisons, contributing to a
Healthcare 2024,12, 2535 11 of 13
more comprehensive understanding of the psychological needs of individuals with chronic
health concerns, including cancer survivors.
5. Conclusions
Understanding fundamental psychological needs is essential for fostering intrinsic
motivation, which drives self-directed behaviors and enhances well-being among cancer
survivors. This study establishes that the K-BPNSFS is a valid, reliable, and culturally
appropriate tool for assessing the satisfaction and frustration of each BPN in a cohort of
Korean cancer survivors.
Utilizing the K-BPNSFS enables a comprehensive assessment of the unique psycho-
logical needs of cancer survivors, marking a crucial step in promoting intrinsic motivation
and self-determined behaviors that contribute to psychological well-being. To further
confirm the K-BPNSFS as an essential tool for clinical guidance, additional studies are rec-
ommended involving cancer populations with varied cancer types and socio-demographic
characteristics. Such studies would enhance the evidence base for the K-BPNSFS’s applica-
bility, thereby providing valuable insights that could inform clinical practices for fostering
intrinsic motivation and self-driven behaviors throughout the cancer journey.
Author Contributions: Conceptualization, H.-E.Y. and J.L.; data curation, J.L.; formal analysis,
H.-E.Y. and J.L.; funding acquisition, H.-E.Y.; investigation, H.-E.Y.; methodology, H.-E.Y. and J.L.;
project administration, H.-E.Y.; software, J.L.; supervision, H.-E.Y.; validation, H.-E.Y. and J.L.;
writing—original
draft, H.-E.Y.; writing—review and editing, H.-E.Y. and J.L. All authors have read
and agreed to the published version of the manuscript.
Funding: This research was supported by Chungnam National University Research Funds.
Institutional Review Board Statement: The Institutional Review Boards approved the purposes and
procedures for primary studies: the Institutional Review Boards at Chungnam National University
(approval number: 202101-SB-009-01, approval date: 3 March 2021) and Chungnam National Univer-
sity Hospital (approval number: 2021-06-080-006, approval date: 30 August 2021), from which the
current study’s data were drawn.
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.
Data Availability Statement: The data supporting this study’s findings are not publicly available
since participants did not give written consent for their data to be shared publicly.
Acknowledgments: We express our great gratitude to all the participants who responded to the
surveys in this study.
Conflicts of Interest: The authors declare no conflicts of interest.
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